Proscovia Nabunya, MSW, PhD, Assistant Professor, Washington University in Saint Louis, St. Louis, MO
Natasja Magorokosho, M.A, Student, Washington University in Saint Louis, Saint Louis, MO
Samuel Kizito, MBChB, MS, Research fellow, Washington University in St. Louis, St Louis, MO
Josephine Nabayinda, Msc, Doctoral student, Washington University in Saint Louis, Saint Louis, MO
Edward Nsubuga, Project Coordinator, International Center for Child Health and Development, Uganda
Ozge Sensoy Bahar, PhD, Research Assistant Professor, Washington University in Saint Louis, MO
Flavia Namuwonge, MBA, Study Coordinator, International Center for Child Health and Development, Uganda
Jennifer Nattabi, MSW, Student, Washington University in Saint Louis, St. Louis, MO
Susan Witte, PhD, LCSW, Professor, Columbia University, New York, NY
Fred Ssewamala, PhD, William E. Gordon Distinguished Professor, Washington University in Saint Louis, St. Louis, MO
Women engaged in commercial sex work (WESW) are at a higher risk of acquiring and transmitting HIV. In sub-Saharan Africa, the HIV prevalence among WESW is estimated at 37%. In Uganda, HIV prevalence among WESW is estimated at 31.3%, higher than the general female population at 6.8%. WESW accounts for 18% of all new HIV infections. WESW are very mobile and their socioeconomic and behavioral vulnerabilities play a critical role in determining their movements for sex work. Mobility impact WESW’s access to and utilization of HIV related health services, including HIV prevention and risk reduction services, as well continued engagement in care, which in turn accelerate their high burden of HIV, risk of HIV transmission and poor treatment outcomes. This study examined the factors associated with the likelihood of mobility among WESW participating in an HIV risk reduction intervention in southern Uganda.
Methods: Data from a longitudinal cluster randomized study involving 542 WESW (18-55 years), recruited from 19 HIV hotspots were analyzed. WESW were eligible if they were 18 years and above, exchanged sex for money or other goods and services in the last thirty days and reported one episode of unprotected sex. Data were collected at baseline, 6, 12, 18 and 24 month. The likelihood of mobility was measured by change in residence by WESW between baseline, 6 months and 12 months follow up. Participants who changed residence were considered mobile and those who never non-mobile. Generalized estimating equations were constructed to predict the correlates of likelihood of mobility among WESW.
Results: Preliminary analyses indicate that young age (b=-0.022, 95% CI=-0.036, -0.01, p=0.02), large household size (b=0.142, 95% CI= 0.069, 0.21, p<0.000), less children in the household (b=-0.19, 95% CI= -0.29, -0.10, p<0.000), alcohol use (b=0.12, 95% CI= 0.08, 0.16, p<0.000) and drug use (b=0.16, 95% CI= 0.12, 0.22, p<0.000) were associated with high likelihood of mobility among WESW. Married or in a relationship (b=-0.09, 95% CI= -0.17, -0.02, p=0.012), locality: rural community (b=-0.43, 95% CI= -0.71, -0.15, p=0.002), small towns (b=-0.52, 95% CI= -0.24, -0.8, p<0.000) and lower scores of post-traumatic stress disorder (PTSD) (b=-0.03, 95% CI= -0.04, -0.016, p<0.000) were associated with lower likelihood of mobility among WESW.
Conclusions: Preliminary results show that individual factors, behavioral factors and mental health-related challenges are associated with a high likelihood of mobility among WESW in Uganda. These results point to the need to address these factors in order to facilitate continued access to HIV related health care services among WESW, especially those in low resource settings.